blood tests vs ultra sounds

I am so confused! I have been diagnosed with cirrhosis after a stay in hospital with ascites. What do they pay more attention to the scans or the blood work? It’s so confusing. They say at scans they are for only surveillance of cancerous lesions but can they tell if the cirrhosis has gotten worse even if your bloods are perfect? Tia

[AyrshireK]

It will be blood tests and symptoms that determine how well or poorly your liver is performing (that's how they determine transplant neediness, UKELD and MELD scores which can 'score' the progression of illness or indeed improvement etc.) 6 monthly scans are to check for the possible appearance of lesions, fluid build up, portal veinous flow and health of other abdominal organs. Scans can't really determine if the tissues are getting worse.

Katie

[Hidden in reply to AyrshireK]

Thank you ! And can they tell how much of your liver has scarred ? Ifs it’s a little to a lot ? Thank you

[AyrshireK in reply to Hidden]

If you've had decompensated cirrhosis with ascites you can assume that your liver is pretty badly scarred.

I don't believe there is any one test that can accurately say how much of liver has scarred.

Ultrasound can certainly report on the size, texture and shape of the whole liver.

[Hidden in reply to AyrshireK]

Thank you, I’ve read lots of your replies and posts and I have learned so much, they have given me so much insight and information. They have given me hope and strength. Just wanted to say a big thank you as my mental health has improved greatly because of them . Especially when I’ve felt so alone in the middle of the night - scared., I’ll come accross one of your posts and it will make me feel better.

So thank you xx

[PerpetuallySad in reply to Hidden]

I’d like to second this. You’re so incredible Ayrshire xx

[Kristian]

It's really about getting as bigger picture as possible. How well your liver is working, as Katy says, is best seen from certain blood tests. However, this is supplemented by the scans which add to the overall diagnostic picture. It's not necessarilly one or the other, more a combination of both.It's also worth remembering, that the liver can work pretty well, even with quite a lot of scarring. So blood tests alone may not always show the full picture at a given point in time. Its more about a picture over time. It's the trends that tend to be looked at.

Appreciate this is probably not the straight forward answer you were hoping for. Unfortunately, that always seems to be the case with liver disease in my experience. It's a combination of factors that help give a proxy for how much scarring may be present.

The important thing though is how well the liver is coping despite how much scarring may or may not be present. That ultimately will be the determining factor and for that the key decisions come from the blood tests. Symptoms do play a part too, but the algorithms used rely on certain blood tests.

Hope thats at least a little bit helpful.

[Hidden in reply to Kristian]

Thank you , yes it does thanks for taking the time to explain.

[cammeag]

Hi. If you were admitted with ascites then that pretty much says that the liver is not in the best place. It is only human to think and fear the worst and without doubt, having ascites is a clear red flag about your health. You didn’t mention the cause of your admission with ascites but if it is alcohol then no doubt that must be something to be avoided in the weeks, months and years ahead. Life can still be pretty good with a cirrhotic liver as long as we look after ourselves and eat the proper food along with good rest. Before my liver became decompensated I used to think I could gauge how bad the liver was and I was always hoping there was enough good liver to accommodate my alcohol excesses…it doesn’t work like that and when the liver finally goes, it can mean a very difficult road ahead. I do hope your recovery goes well and that your fears can be allayed with good advice and a positive plan.

[Hidden in reply to cammeag]

Yes was because of alcohol, I have given this up for a year now eat healthy although do enjoy an ice cream. Keep an eye on my salt intake etc. I am a healthy weight and exercise often in fact now as it’s has gone I don’t have any symptoms at the moment bloods are going in right direction all coming back to normal range. Just was thinking was this going to get worse whatever I do . As the consultant said to me you can do all the right things but it still go wrong. I left terrified

[Readlots in reply to Hidden]

Next time you’re feeling down read Nip1s post. Always good to hear that it can be worthwhile

[cammeag in reply to Hidden]

Your consultant sounds like a truly positive chap😁…they cannot definitively set length of years on our livers. If they present worst case scenario, then they are covered. I would look at the positives mate. The way your body has responded to your looking after it. I was given a 40% chance of living two year, that was four years ago. It takes time but the liver can and does, in the majority of cases where it is no longer abused, find ways of letting us have a pretty decent life. PM me if you ever want to exchange diet sheets and exercise regimes 😁👍

[Confused2024 in reply to cammeag]

The confusing part to me is that I thought fibroscan/elastology told them how much scarring there is? I had ascites and that was what alerted a problem...but less than two years before that I had sever fatty liver which very sadly I was not informed of and continued to drink which I have not had a drop of since I had ascites int he summer. I am confused as to how ascites alone proves that the liver is in such bad shape - it is of course - but does that necessarily mean there is a ton of scarring or could it have been acute due to inflammation as I was 17.4 cm at the time...my bloodwork came almost normal within one month of quitting alcohol...I had a nodular contour but it did not show up and a mild minimal contour irregularity of the contour at the subscapsular area of the liver...the mild contour did not show up last time - praying it could have gone? My elastology was 11.8 kpa and then in oct 9.0 kPa...still on a waitlist to see a hep Dr but my GP says cirrhosis...the last eleastology ultrasound the radiologist said impression was hepatic steatoisis but the minimal irregularity would not exclude possible early cirrhotic change....so I honestly am not even conviinced I do have it. I have no other symptoms and go to the gym lots am 110 lbs and eat healthy so just going to keep all that up and pray with all my heart I have another chance...I recommend you do the same because sometimes they can be wrong or there just might be a chance you are still early enough for reversal.

I do not know enough about ascites - I understood most people would be very sick but the time they got ascites and I was not at al...and I understood most would have a very high fibroscan (much higher than 9.0 kPa) usually on presentation but I also know there are anomolies to all of this....maybe most people aren't sick by the time ascites kicks in or also have a low kPa?

Don;t give up - stay as positive as you can!!

[Confused2024 in reply to Confused2024]

and my liver is fairly homogenous with normal echogenecity - I just do not see how any of this fits other than the ascites?

[D6C2L30E-48 in reply to Confused2024]

Ascites can be caused by alcohol hepatitis aswell you don't have to have cirrhosis to have ascites

[Confused2024 in reply to D6C2L30E-48]

yes but I was not sick at all...I was told if you had AH and ascites you would be very sick...I wasnt?